Provider Demographics
NPI:1104154533
Name:COLLEGE COMMUNITY SERVICES
Entity type:Organization
Organization Name:COLLEGE COMMUNITY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STATE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GINTER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CBCS
Authorized Official - Phone:657-465-9497
Mailing Address - Street 1:8337 TELEGRAPH RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4957
Mailing Address - Country:US
Mailing Address - Phone:562-467-5440
Mailing Address - Fax:562-467-5553
Practice Address - Street 1:2717 NUGGET AVENUE
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240
Practice Address - Country:US
Practice Address - Phone:760-379-3412
Practice Address - Fax:760-379-5332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health